Author:
- INTRODUCTION
- MATERIALS AND METHODS
- RESULTS
- DISCUSSION
- Animal and human feces are common in rural households observed in this study.
- Ingestion of soil and chicken feces could account for a high load of bacterial ingestion in the Zambia context.
- Mouthing behaviors place IYC at risk for fecal–oral microbial transmission.
- Caregiver and IYC handwashing practices are not fully used.
- Summary.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Black MM, Dewey KG, 2014. Promoting equity through integrated early child development and nutrition interventions. Ann N Y Acad Sci 1308: 1–10.
-
2.
Caulfield LE, de Onis M, Blössner M, Black RE, 2004. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 80: 193–198.
-
3.
Hoddinott J, Alderman H, Behrman JR, Haddad L, Horton S, 2013. The economic rationale for investing in stunting reduction. Matern Child Nutr 9 (Suppl 2): 69–82.
-
4.
Walker SP et al. 2011. Inequality in early childhood: risk and protective factors for early child development. Lancet 378: 1325–1328.
-
5.
Dewey KG, Adu-Afarwuah S, 2008. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr 4 (Suppl 1): 24–85.
-
6.
Humphrey JH, 2009. Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet 374: 1032–1035.
-
7.
Spears D, 2013. How Much International Variation in Child Height Can Sanitation Explain? World Bank Policy Research Working Paper No. 6351. Available at : https://ssrn.com/abstract=2212559. Accessed October 15, 2016.
-
8.
Solomons NW, 2003. Environmental contamination and chronic inflammation influence human growth potential. J Nutr 133: 1237.
-
9.
Lunn PG, Northrop-Clewes CA, Downes RM, 1991. Intestinal permeability, mucosal injury, and growth faltering in Gambian infants. Lancet 338: 907–910.
-
10.
Lin A et al. 2013. Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg 89: 130–137.
-
11.
George CM et al. 2015. Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh. Am J Trop Med Hyg 92: 1117–1124.
-
12.
Ngure FM, Reid BM, Humphrey JH, Mbuya MN, Pelto G, Stoltzfus RJ, 2014. Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links. Ann N Y Acad Sci 1308: 118–128.
-
13.
Dangour AD, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, Cavill S, Allen E, Uauy R, 2013. Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. Cochrane Database Syst Rev 8: CD009382.
-
14.
Ngure FM et al. 2013. Formative research on hygiene behaviors and geophagy among infants and young children and implications of exposure to fecal bacteria. Am J Trop Med Hyg 89: 709–716.
-
15.
Ngure FM, Humphrey JH, Menon P, Stoltzfus R, 2013. Environmental Hygiene, Food Safety and Growth in Less than Five Year Old Children in Zimbabwe and Ethiopia. Ithaca, NY: Division of Nutritional Sciences, Cornell University.
-
16.
Mosites EM, 2015. The influence of livestock ownership and health on the nutritional status of children in Eastern Africa. PhD dissertation, Department of Epidemiology, University of Washington, Seattle, WA.
-
17.
Mbuya MN et al. Sanitation Hygiene Infant Nutrition Efficacy Trial Team, 2015. Design of an intervention to minimize ingestion of fecal microbes by young children in rural Zimbabwe. Clin Infect Dis 61 (Suppl 7): S703–S709.
-
18.
Mbuya MN, Humphrey JH, 2016. Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries. Matern Child Nutr 12 (Suppl 1): 106–120.
-
19.
Hathi P, Haque S, Pant L, Coffey D, Spears D, 2017. Place and child health: the interaction of population density and sanitation in developing countries. Demography 54: 337–360.
-
20.
Marquis GS, Ventura G, Gilman RH, Porras E, Miranda E, Carbajal L, Pentafiel M, 1990. Fecal contamination of shanty town toddlers in households with non-corralled poultry, Lima, Peru. Am J Public Health 80: 146–149.
-
21.
Zambian Central Statistical Office, Zambian Ministry of Head, 2014. Zambia Demographic and Health Survey 2013–14. Lusaka, Zambia, and Baltimore, MD: Central Statistical Office, Ministry of Health, and ICF International.
-
22.
Lawrence JJ, Yeboah-Antwi K, Biemba G, Ram PK, Osbert N, Sabin LL, Hamer DH, 2016. Beliefs, behaviors, and perceptions of community-led total sanitation and their relation to improved sanitation in rural Zambia. Am J Trop Med Hyg 94: 553–562.
-
23.
Orcutt M, 2013. Maternal mortality in eastern Zambia: accessing health care for delivery and obstetric emergencies. World Transp Policy Pract 19: 9–28.
-
24.
Marten L, Kula NC, 2008. Zambia: ‘One Zambia, one nation, many languages’. Simpson A, ed. Language and National Identity in Africa. Oxford, United Kingdom: Oxford University Press, 291–313.
-
25.
Mushibwe CP, 2014. What are the Effects of Cultural Traditions on the Education of Women? (The Study of the Tumbuka People of Zambia). Hamburg, Germany: Anchor Academic Publishing.
-
26.
Humphrey JH et al. Sanitation Hygiene Infant Nutrition Efficacy Trial Team, 2015. The sanitation hygiene infant nutrition efficacy (SHINE) trial: rationale, design, and methods. Clin Infect Dis 61 (Suppl 7): S685–S702.
-
27.
UNICEF, 2015. Multiple Indicator Cluster Surveys (MICS). Series of Country Surveys. New York, NY: UNICEF.
-
28.
Curtis VA, Danquah LO, Aunger RV, 2009. Planned, motivated and habitual hygiene behavior: an eleven country review. Health Educ Res 24: 655–673.
-
29.
Teunis PF, Reese HE, Null C, Yakubu H, Moe CL, 2016. Quantifying contact with the environment: behaviors of young children in Accra, Ghana. Am J Trop Med Hyg 94: 920–931.
| Past two years | Past Year | Past 30 Days | |
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| Abstract Views | 749 | 487 | 23 |
| Full Text Views | 596 | 9 | 0 |
| PDF Downloads | 232 | 15 | 0 |
Characterizing Potential Risks of Fecal–Oral Microbial Transmission for Infants and Young Children in Rural Zambia
Brie Reid
Brie Reid
Institute of Child Development, University of Minnesota, Minneapolis, Minnesota;
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Jennifer Orgle
Jennifer Orgle
CARE USA, Atlanta, Georgia;
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Khrist Roy
Khrist Roy
CARE USA, Atlanta, Georgia;
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Catherine Pongolani
Catherine Pongolani
CARE International Zambia, Lusaka, Zambia;
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Modesta Chileshe
Modesta Chileshe
University of North Carolina, Kamwala-ECHO Site, Lusaka, Zambia;
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Rebecca Stoltzfus
Rebecca Stoltzfus
Division of Nutritional Sciences, Cornell University, Ithaca, New York
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Undernourished children in low-income contexts often suffer from environmental enteric disorder—damage to the intestines probably caused by chronic exposure to bacterial pathogens from feces. We aimed to identify strategies for reducing infants and young children’s (IYC) exposure to human and animal feces in rural farming families by conducting direct observation of 30 caregiver–infant dyads for 143 hours and recording water, sanitation, and hygiene (WASH)–related behaviors to identify possible pathways of fecal–oral transmission of bacteria among IYC in rural Zambia. In addition to mouthing visibly dirty hands, toys, sibling’s body parts, and food, 14 IYC actively ingested 6.1 ± 2.5 (mean ± standard deviation [SD]) pieces of soil and stones and one ingested animal feces 6.0 ± 0 times in the span of 5 hours. Ninety-three percent (21 of 30) of mothers reported observing the index-child eating soil and 17% (5 of 30) of mothers reported observing the index-child eating chicken feces. Adult and child handwashing was uncommon, and even though 70% (28 of 30) of households had access to a latrine, human feces were found in 67% of homestead yards. Most animals present in the household were un-corralled, and the highest observable counts of feces came from chickens, pigs, and cattle. To protect IYC in low-income communities from the exploratory ingestion of feces and soil, Baby WASH interventions will need to interrupt fecal–oral microbial transmission vectors specific to IYC with a focus on feasibility, caregiver practices, and local perceptions of risk.
Author Notes
Financial support: This study was supported by the Atkinson Center for a Sustainable Future at Cornell University.
Authors’ addresses: Brie Reid, Institute of Child Development, University of Minnesota, Minneapolis, MN, E-mail: reidx189@umn.edu. Jennifer Orgle and Khrist Roy, CARE USA, Atlanta, GA, E-mails: jorgle@care.org and kroy@care.org. Catherine Pongolani, CARE International Zambia, Lusaka, Zambia, E-mail: pongolanic@carezam.org. Modesta Chileshe, University of North Carolina, Kamwala-ECHO Site, Lusaka, Zambia, Email; modesta.chileshe@unclusaka.org. Rebecca Stoltzfus, Division of Nutritional Sciences, Cornell University, Ithaca, NY, E-mail: rjs62@cornell.edu.
- INTRODUCTION
- MATERIALS AND METHODS
- RESULTS
- DISCUSSION
- Animal and human feces are common in rural households observed in this study.
- Ingestion of soil and chicken feces could account for a high load of bacterial ingestion in the Zambia context.
- Mouthing behaviors place IYC at risk for fecal–oral microbial transmission.
- Caregiver and IYC handwashing practices are not fully used.
- Summary.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Black MM, Dewey KG, 2014. Promoting equity through integrated early child development and nutrition interventions. Ann N Y Acad Sci 1308: 1–10.
-
2.
Caulfield LE, de Onis M, Blössner M, Black RE, 2004. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 80: 193–198.
-
3.
Hoddinott J, Alderman H, Behrman JR, Haddad L, Horton S, 2013. The economic rationale for investing in stunting reduction. Matern Child Nutr 9 (Suppl 2): 69–82.
-
4.
Walker SP et al. 2011. Inequality in early childhood: risk and protective factors for early child development. Lancet 378: 1325–1328.
-
5.
Dewey KG, Adu-Afarwuah S, 2008. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr 4 (Suppl 1): 24–85.
-
6.
Humphrey JH, 2009. Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet 374: 1032–1035.
-
7.
Spears D, 2013. How Much International Variation in Child Height Can Sanitation Explain? World Bank Policy Research Working Paper No. 6351. Available at : https://ssrn.com/abstract=2212559. Accessed October 15, 2016.
-
8.
Solomons NW, 2003. Environmental contamination and chronic inflammation influence human growth potential. J Nutr 133: 1237.
-
9.
Lunn PG, Northrop-Clewes CA, Downes RM, 1991. Intestinal permeability, mucosal injury, and growth faltering in Gambian infants. Lancet 338: 907–910.
-
10.
Lin A et al. 2013. Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg 89: 130–137.
-
11.
George CM et al. 2015. Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh. Am J Trop Med Hyg 92: 1117–1124.
-
12.
Ngure FM, Reid BM, Humphrey JH, Mbuya MN, Pelto G, Stoltzfus RJ, 2014. Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links. Ann N Y Acad Sci 1308: 118–128.
-
13.
Dangour AD, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, Cavill S, Allen E, Uauy R, 2013. Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. Cochrane Database Syst Rev 8: CD009382.
-
14.
Ngure FM et al. 2013. Formative research on hygiene behaviors and geophagy among infants and young children and implications of exposure to fecal bacteria. Am J Trop Med Hyg 89: 709–716.
-
15.
Ngure FM, Humphrey JH, Menon P, Stoltzfus R, 2013. Environmental Hygiene, Food Safety and Growth in Less than Five Year Old Children in Zimbabwe and Ethiopia. Ithaca, NY: Division of Nutritional Sciences, Cornell University.
-
16.
Mosites EM, 2015. The influence of livestock ownership and health on the nutritional status of children in Eastern Africa. PhD dissertation, Department of Epidemiology, University of Washington, Seattle, WA.
-
17.
Mbuya MN et al. Sanitation Hygiene Infant Nutrition Efficacy Trial Team, 2015. Design of an intervention to minimize ingestion of fecal microbes by young children in rural Zimbabwe. Clin Infect Dis 61 (Suppl 7): S703–S709.
-
18.
Mbuya MN, Humphrey JH, 2016. Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries. Matern Child Nutr 12 (Suppl 1): 106–120.
-
19.
Hathi P, Haque S, Pant L, Coffey D, Spears D, 2017. Place and child health: the interaction of population density and sanitation in developing countries. Demography 54: 337–360.
-
20.
Marquis GS, Ventura G, Gilman RH, Porras E, Miranda E, Carbajal L, Pentafiel M, 1990. Fecal contamination of shanty town toddlers in households with non-corralled poultry, Lima, Peru. Am J Public Health 80: 146–149.
-
21.
Zambian Central Statistical Office, Zambian Ministry of Head, 2014. Zambia Demographic and Health Survey 2013–14. Lusaka, Zambia, and Baltimore, MD: Central Statistical Office, Ministry of Health, and ICF International.
-
22.
Lawrence JJ, Yeboah-Antwi K, Biemba G, Ram PK, Osbert N, Sabin LL, Hamer DH, 2016. Beliefs, behaviors, and perceptions of community-led total sanitation and their relation to improved sanitation in rural Zambia. Am J Trop Med Hyg 94: 553–562.
-
23.
Orcutt M, 2013. Maternal mortality in eastern Zambia: accessing health care for delivery and obstetric emergencies. World Transp Policy Pract 19: 9–28.
-
24.
Marten L, Kula NC, 2008. Zambia: ‘One Zambia, one nation, many languages’. Simpson A, ed. Language and National Identity in Africa. Oxford, United Kingdom: Oxford University Press, 291–313.
-
25.
Mushibwe CP, 2014. What are the Effects of Cultural Traditions on the Education of Women? (The Study of the Tumbuka People of Zambia). Hamburg, Germany: Anchor Academic Publishing.
-
26.
Humphrey JH et al. Sanitation Hygiene Infant Nutrition Efficacy Trial Team, 2015. The sanitation hygiene infant nutrition efficacy (SHINE) trial: rationale, design, and methods. Clin Infect Dis 61 (Suppl 7): S685–S702.
-
27.
UNICEF, 2015. Multiple Indicator Cluster Surveys (MICS). Series of Country Surveys. New York, NY: UNICEF.
-
28.
Curtis VA, Danquah LO, Aunger RV, 2009. Planned, motivated and habitual hygiene behavior: an eleven country review. Health Educ Res 24: 655–673.
-
29.
Teunis PF, Reese HE, Null C, Yakubu H, Moe CL, 2016. Quantifying contact with the environment: behaviors of young children in Accra, Ghana. Am J Trop Med Hyg 94: 920–931.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 749 | 487 | 23 |
| Full Text Views | 596 | 9 | 0 |
| PDF Downloads | 232 | 15 | 0 |